92 Decision Citation: BVA 92-15494
Y92
BOARD OF VETERANS' APPEALS
WASHINGTON, D.C. 20420
DOCKET NO. 90-18 420 ) DATE
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THE ISSUES
1. Entitlement to service connection for a disorder
manifested by chronic anterior chest wall syndrome.
2. Entitlement to service connection for a disorder
manifested by diffuse arthralgias and myalgias of the upper
and lower extremities.
3. Entitlement to service connection for Scheuerman's
disease of the spine.
4. Entitlement to service connection for recurrent
pharyngotonsillitis.
5. Entitlement to service connection for mitral valve
prolapse syndrome.
6. Entitlement to service connection for gastroesophageal
reflux.
REPRESENTATION
Appellant represented by: Veterans of Foreign Wars
of the United States
ATTORNEY FOR THE BOARD
R. E. Smith, Associate Counsel
INTRODUCTION
The veteran entered his last period of active duty in
December 1986 and was discharged from active duty in
February 1989 due to physical disability with severance pay
for almost eleven years of service. Prior service dates are
not of record.
This matter came before the Board of Veterans' Appeals
(hereinafter Board) on appeal from an October 1989 rating
decision from the Buffalo, New York Regional Office
(hereinafter RO), which the veteran was informed of that
same month. The notice of disagreement with this action was
received in December 1989. A statement of the case was
issued in December 1989. The substantive appeal was
received in February 1990. The appeal was initially
received by the Board in April 1990. Following additional
written argument by the veteran's representative, the
Veterans of Foreign Wars of the United States (VFW), in
November 1990, the claim was remanded to the RO for further
development by a Board decision in April 1991. Thereafter,
following a July 1991 Department of Veterans Affairs (VA)
examination, the RO by a rating decision in September 1991
confirmed its earlier October 1989 rating decision and a
supplemental statement of the case was then issued in
October 1991. The appeal was again received by the Board in
April 1992. Following further argument by the VFW in May
1992, the case is now ready for appellate review.
The first two issues, as characterized on page 1, are those
developed and certified for appellate review. However, as
will become evident below, the Board feels that the
additional issues (numbers 3. through 6.) are also on appeal
and are inextricably entertwined with issues numbers 1. and
2. All issues will be considered.
CONTENTIONS OF APPELLANT ON APPEAL
The appellant contends that the RO committed error in
denying him entitlement to service connection for disorders
manifested by chronic anterior [chest] wall syndrome and
arthralgias and myalgias of the upper and lower
extremities. In this regard, the appellant contends that he
sustained an injury to his chest while in basic training
which resulted in chronic disability manifested by recurrent
chest pains. The veteran also contends that discomfort in
his extremities developed while he was on active duty and
has progressively worsened since that time. Attention also
has been drawn to the pertinent VA regulatory provisions
governing line-of-duty determinations by service
departments.
DECISION OF THE BOARD
For the reasons and bases hereinafter set forth, it is the
decision of the Board that the preponderance of the evidence
supports the veteran's claims for service connection for a
disorder manifested by chronic anterior chest wall syndrome,
a disorder manifested by diffuse arthralgias and myalgias of
the upper and lower extremities, Scheuerman's disease of the
spine, recurrent pharyngotonsillitis, mitral valve prolapse
syndrome and gastroesophageal reflux.
FINDINGS OF FACT
1. Disorders manifested by chronic anterior chest wall
syndrome and diffuse arthralgias and myalgias of the upper
and lower extremities were of service origin.
2. Scheuerman's disease of the spine, recurrent
pharyngotonsillitis, mitral valve prolapse syndrome and
gastroesophageal reflux originated in service and are
currently shown.
CONCLUSIONS OF LAW
1. A disorder manifested by chronic anterior chest wall
syndrome was incurred in peacetime service. 38 U.S.C.
§§ 1131, 5107 (1992); 38 C.F.R. § 3.303(d) (1991).
2. A disorder manifested by diffuse arthralgias and
myalgias of the upper and lower extremities was incurred in
peacetime service. 38 U.S.C. §§ 1131, 5107 (1992);
38 C.F.R. § 3.303(d) (1991).
3. Scheuerman's disease of the spine was incurred in active
peacetime service. 38 U.S.C. §§ 1131, 5107 (1992);
38 C.F.R. § 3.303(d) (1991).
4. Recurrent pharyngotonsillitis was incurred in active
peacetime service. 38 U.S.C. §§ 1131, 5107 (1992);
38 C.F.R. § 3.303(d) (1991).
5. Mitral valve prolapse syndrome was incurred in active
peacetime service. 38 U.S.C. §§ 1131, 5107 (1992);
38 C.F.R. § 3.303(d) (1991).
6. Gastroesophageal reflux was incurred in active peacetime
service. 38 U.S.C. §§ 1131, 5107 (1992); 38 C.F.R.
§ 3.303(d) (1991).
REASONS AND BASES FOR FINDINGS AND CONCLUSIONS
Initially, we note that we have found that the veteran's
claim is "well grounded" within the meaning of 38 U.S.C.
§ 5107. That is, we find that the veteran has presented a
claim which is plausible. Furthermore, we are also
satisfied that all relevant facts have been properly
developed and that the clinical data on file are sufficient
for us to render a fair and equitable determination of the
matter at hand.
The veteran's service medical records, including his report
of a Medical Board Evaluation dated in July 1988, reflect
that the veteran had been treated in service for severe
anterior chest wall pain since August 1978, which he
attributed to a traumatic episode in boot camp. He also was
treated and evaluated for pain and stiffness in his upper
and lower extremities beginning in 1981. The veteran's
treatment, consisting of a variety of medications including
nonsteroidal anti-inflammatory drugs, analgesics, muscle
relaxants, and physical therapy, was reportedly without
benefit. His symptoms were reported to worsen in service,
with no signs of inflammatory disease or systemic rheumatic
disease.
On his July 1988 Medical Evaluation Board report, it was
recorded that over the prior years he had been evaluated in
several military health care settings and in a civilian
hospital and by general internal medicine, cardiology,
orthopedics, rheumatology, physical therapy, anesthesia,
neurology, general surgery, thoracic surgery, and radiology
departments. The undiagnostic studies had included
electromyograms, nerve conduction velocities, chest X-rays,
special rib series, radiographic studies, tomograms of the
sternum, pulmonary function studies, cardiac exercise stress
test (treadmill), electrocardiograms, and echocardiograms
and both evaluations and studies failed to document any
evidence of systemic rheumatic disease or inflammatory joint
disease. The Medical Evaluation Board opined that the
veteran had a chronic and persistent pain pattern which
could not be further evaluated which had been resistant to
all attempts at therapy and interfered with the performance
of his duties. It was noted that "this disease" did not
exist prior to his enlistment. In pertinent part, chronic
anterior chest wall syndrome, most compatible with chronic
osteochondritis and diffuse arthralgias and myalgias of the
extremities of undetermined etiology, was the diagnosis
recorded by the Medical Evaluation Board.
Thereafter, a Physical Evaluation Board, in September 1988,
found the veteran to be unfit for further military service
because of physical disability.
In April 1989, the veteran was accorded his initial
Department of Veterans Affairs (VA) examination. On this
examination, the veteran complained of recurrent pain in the
chest wall and extremities. He further related that his
pain resulted from a traumatic incident during basic
training, in April 1978, and that, over a period of
11 years, his pain had increased and spread to both arms,
hands, and legs. He added that he had been seen since 1978
by more than 50 physicians for his complaints. On
examination, at that time, his cardiovascular system was
essentially normal and the chest wall showed no deformity or
local swelling or tenderness. The veteran's respiratory
system was also within normal limits, with no abnormality
demonstrated on palpation, percussion, or auscultation. On
musculoskeletal examination, the anterior chest wall showed
no evidence of muscle atrophy and mobility of the chest wall
was characterized as good. No sensory or motor deficit was
demonstrated and range of motion of the musculoskeletal
system on evaluation was characterized as "OK."
An X-ray of the veteran's chest revealed clear lungs with no
evidence of active pulmonary disease and the cardiac size
and pulmonary vascularity were normal. The visualized
osseous structures were intact. On RMS (physical therapy)
examination, the anterior chest wall was grossly within
normal limits. The active range of motion of both the upper
and lower extremities was characterized as normal with no
signs of deformity, swelling, or tenderness. The left
shoulder demonstrated bicipital groove tenderness and a
positive trigger point. Chronic bicipital tendinitis was
the diagnostic assessment.
A rheumatology examination noted no joint swelling/effusion
or deformity and good range of motion. Joint tenderness
along the costochondral joints and in many discrete points
along the back was noted. Fibromyalgia syndrome was the
diagnostic assessment.
A subsequent VA outpatient treatment record dated in June
1989 recorded that the veteran had no relief whatsoever with
medication prescribed for questionable fibromyalgic syndrome
and had recently started to experience increased symptoms in
both lower extremities.
On the veteran's most recent VA examination in July 1991, he
continued to exhibit numerous pain complaints involving the
shoulders, knees, legs, and the anterior chest. It was
recorded that he had at no time noticed any joint swelling
or redness and noted no history of limitation of range of
motion because of his complaints. A neurological
examination was essentially normal with motor examination
revealing no focal, motor weakness, or wasting and he had
full functional ability. Deep tendon reflexes were
symmetric in the biceps, triceps, and brachioradialis,
although it was noted that they were slightly increased at
the knees and ankles. His plantar responses were flexor and
sensory examination revealed no diminution to touch,
proprioception, or vibration on the trunk and the
extremities. There were no pathologic reflexes. The
neurological examiner opined that there was no evidence
clinically of a peripheral neuropathy and suggested that the
veteran had a probable fibromyalgic syndrome.
Mild gastroesophageal reflux was noted on an air contrast
esophagram and upper gastrointestinal series, but otherwise
the test was normal. General examination noted that the
anterior chest wall showed no pain or tenderness on
palpation and there was no inflammation, redness, or soft
tissue swelling noted. The veteran's extremities revealed
no limitation of motion and no lymphadenopathy was
palpated. Anterior chest wall syndrome was the diagnosis.
Under the governing laws and regulations, service connection
may be granted for disease or injuries incurred or
aggravated by peacetime service. 38 U.S.C. § 1131. In this
case, the objective evidence documents that the veteran had
made various complaints of pain in service and subsequent to
service. While the veteran has been extensively evaluated
both in service and thereafter, no definite chronic
underlying pathology associated with the veteran's
complaints has been identified. The Board notes, however,
that the latest findings are consistent with those shown in
service which led to diagnoses of chronic anterior chest
wall syndrome; diffuse arthralgias and myalgias of the
extremities; Scheuerman's disease of the spine; recurrent
pharyngotonsillitis; and mitral valve prolapse syndrome. In
addition, a VA examination showed gastroesophageal reflux.
Accordingly, it is appropriate to grant service connection
for all of these disorders.
ORDER
Service connection for a disorder manifested by chronic
anterior wall syndrome is granted.
Service connection for a disorder manifested by diffuse
arthralgias, and myalgias of the upper and lower extremities
is granted.
Service connection for Scheuerman's disease of the spine is
granted.
Service connection for recurrent pharyngotonsillitis is
granted.
Service connection for mitral valve prolapse syndrome is
granted.
Service connection for gastroesophageal reflux is granted.
(CONTINUED ON NEXT PAGE)
BOARD OF VETERANS' APPEALS
WASHINGTON, D.C. 20420
*
C. J. STUREK
*38 U.S.C. § 7102(a)(2)(A) (1992) permits a Board of
Veterans' Appeals Section, upon direction of the Chairman of
the Board, to proceed with the transaction of business
without awaiting assignment of an additional Member to the
Section when the Section is composed of fewer than three
Members due to absence of a Member, vacancy on the Board or
inability of the Member assigned to the Section to serve on
the panel. The Chairman has directed that the Section
proceed with the transaction of business, including the
issuance of decisions, without awaiting the assignment of a
third Member.
NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C. § 7266 (1992),
a decision of the Board of Veterans' Appeals granting less
than the complete benefit, or benefits, sought on appeal is
appealable to the United States Court of Veterans Appeals
within 120 days from the date of mailing of notice of the
decision, provided that a Notice of Disagreement concerning
an issue which was before the Board was filed with the
agency of original jurisdiction on or after November 18,
1988. Veterans' Judicial Review Act, Pub. L. No. 100-687,
§ 402 (1988). The date which appears on the face of this
decision constitutes the date of mailing and the copy of
this decision which you have received is your notice of the
action taken on your appeal by the Board of Veterans'
Appeals.